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  • PART I ADMINISTRATION OF THE GOVERNMENT
  • TITLE XXII CORPORATIONS
  • CHAPTER 175 INSURANCE
  • Section 110G Continuation of coverage under group hospital, surgical or medical insurance plan upon involuntary layoff or death of member

Section 110G. Whenever a member of a group hospital, surgical or medical insurance plan issued or delivered within or without the commonwealth and which covers residents of the commonwealth, other than the one authorized under the provisions of chapter thirty-two A or chapter thirty-two B, becomes ineligible for continued participation in such group plan because of involuntary layoff or death, the coverage originally provided by such plan for the member, his spouse and dependents shall be continued as provided herein for a period of thirty-nine weeks from the date of such ineligibility or until such member, his spouse and dependents become eligible for benefits under another group plan, whichever occurs first but in no event shall such continuation period exceed the period during which the member was most recently covered under such group plan. The employer or policyholder shall notify the involuntary laid-off member, surviving spouse of a deceased member and dependents of their eligibility to participate in such plans. The involuntary laid-off member, surviving spouse of a deceased member and dependents may elect to continue participation in such plan by giving at least thirty days written notice thereof to the employer or policyholder. Such member or surviving spouse or dependents, as the case may be, shall be responsible for the payment of the whole premium due for such coverage, including any and all amounts normally paid by the employer as employee’s benefits, to the employer or policyholder throughout the extension period. After timely receipt of the premium payment from the responsible individual, if the employer or policyholder fails to make payment to the insurer or hospital or medical service corporation with the result that coverage is terminated, the employer or policyholder shall be liable for benefits to the same extent as the insurer or hospital or medical service corporation would have been liable if coverage had not been terminated. Timely receipt of premium payment shall mean the employer’s or policyholder’s receipt of the premium or subscription fee for the extended coverage from such member, surviving spouse or dependent as the case may be within the dates or by the date indicated by the employer or policyholder at the time of the election of extended coverage. Failure to give such notice or to make such premium or subscription fee payment as hereinabove provided shall constitute a waiver of option to have such extended coverage.

In addition, whenever such group hospital, surgical, medical insurance plan or employer’s plan covering health benefits is issued or subsequently renewed within or without the commonwealth by agreement between the insurer and the policyholder and covers residents of the commonwealth, during the period this provision is effective, such plan shall include coverage such that when a member of such group plan becomes ineligible for continued participation in such plan because he is an employee whose employment is terminated due to a plant closing or covered partial closing, as those terms are defined in section seventy-one A of chapter one hundred and fifty-one A, the coverage originally provided by such plan for the member and his dependents shall continue as provided herein, for a period of ninety days from the date of ineligibility or until such member and his dependents become eligible for benefits under another group plan, whichever comes first. Such member and such employer or policyholder shall be responsible for the payment of their respective shares of the premium due as provided in said group plan. In the event that said employer or policyholder closed under the provisions of the Federal Bankruptcy Act, as amended, 11 USC sec. 101 et seq. except for employers or policyholders in reorganization proceedings, such employer’s or policyholder’s share of the premium shall be paid from the health insurance benefits fund established pursuant to section seventy-one E of said chapter one hundred and fifty-one A. The employer or policyholder shall notify the terminated member of their eligibility to participate in such plans. The terminated member may elect to continue participation in such plan by giving written notice thereof to the employer or policyholder. The member whose employment has been terminated shall be responsible for the payment of whatever part of the premium, if any, normally paid by such terminated employee as originally provided in such plan, throughout the ninety day period. If applicable, after timely receipt of the premium payment from the individual, if the employer or policyholder fails to make payment to the insurer or hospital or medical service corporation with the result that the coverage is terminated, the employer or policyholder shall be liable for the benefits to the same extent as the insurer or hospital or medical service corporation would have been liable if coverage had not been terminated. Timely receipt of payment shall mean the employer’s or policyholder’s receipt of the premium or subscription fee for extended coverage from such member within the dates or by the date indicated by the employer or policyholder at the time of the election of extended coverage. Failure to give notice or to make premium payments as hereinabove provided shall constitute a waiver of the option to have such extended coverage. Notwithstanding the provisions of this paragraph, any contractual agreement arrived at by a collective bargaining process that contains provisions requiring an employer to pay for the continuation of such insurance for employees whose employment is terminated by a plant closing or covered partial closing shall supercede the requirements of this paragraph when said contractual agreement provides for at least three months or ninety days continuation of such insurance. Otherwise, the requirements of this paragraph shall be deemed to be controlling.